摘要
目的探究腹腔镜门静脉流域解剖性肝切除术(laparo-scopic portal territory staining guided anatomic liver resection,LPTAR)、腹腔镜下非解剖性肝切除术(laparoscopic non-anatomical hepatectomy,LNAH)治疗原发性肝癌的疗效及安全性。方法回顾性分析2022年7月至2024年10月期间山东第二医科大学附属医院收治的原发性肝癌病人临床资料,按照手术方法分为LNAH组(93例)和LPTAR组(97例),分析2组疗效和安全性。结果LPTAR组手术时间长于LNAH组[(192.24±33.41)min比(167.36±28.57)min],术中出血量少于LNAH组[(312.85±27.13)mL比(347.32±31.97)mL],术后第3天谷丙转氨酶[(116.49±22.64)U/L比(126.33±23.42)U/L]、谷草转氨酶[(84.43±6.39)U/L比(87.56±7.66)U/L]、总胆红素[(32.24±4.26)μmol/L比(34.15±4.74)μmol/L]水平低于LNAH组,差异均有统计学意义(均P<0.05)。LPTAR组和LNAH组无瘤生存率为74.23%、60.22%,2组无瘤生存曲线差异有统计学意义(P=0.004)。LPTAR组和LNAH组总生存率为78.35%、64.52%,差异有统计学意义(P=0.035)。2组病人在是否输血,住院时间,肿瘤标志物,视觉模拟疼痛评分,恢复质量评分,并发症总发生率等方面差异均无统计学意义(均P>0.05)。结论LPTAR和LNAH安全性相当,但LNAH手术时间更短,而LPTAR可减少术中出血量、减轻肝功能损伤,且能降低术后复发率、提高生存率,改善病人疗效。
Objective To explore the therapeutic effects and safety of laparoscopic portal territory staining-guided anatomic liver resection(LPTAR)versus laparoscopic non-anatomical hepatectomy(LNAH)in the treatment of primary liver cancer.Methods Clinical data of patients with primary liver cancer treated in the Affiliated Hospital of Shandong Second Medical University from July 2022 to October 2024 were retrospectively analyzed.Patients were divided into two groups based on surgical methods:the LNAH group(n=93)and the LPTAR group(n=97).The efficacy and safety of the two surgical approaches were analyzed.Results The operation time in the LPTAR group was significantly longer than the LNAH group(192.24±33.41 min vs.167.36±28.57 min),while the intraoperative blood loss was significantly less in the LPTAR group than the LNAH group(312.85±27.13 mL vs.347.32±31.97 mL).At 3 days postoperatively,the levels of alanine aminotransferase(116.49±22.64 U/L vs.126.33±23.42 U/L),aspartate aminotransferase(84.43±6.39 U/L vs.87.56±7.66 U/L),and total bilirubin(32.24±4.26μmol/L vs.34.15±4.74μmol/L)were significantly lower in the LPTAR group compared to the LNAH group(P<0.05).The disease-free survival rate was significantly higher in the LPTAR group than in the LNAH group(74.23%vs.60.22%,P=0.004).The overall survival rate was significantly higher in the LPTAR group than in the LNAH group(78.35%vs.64.52%,P=0.035).There were no significant differences between the two groups in terms of transfusion rate,hospital stay,tumor marker level,visual analogue scale and quality of recovery-15 scores or the overall incidence of complications(P>0.05).Conclusion LPTAR and LNAH have comparable safety profiles.However,LNAH is associated with a shorter operative time.In contrast,LPTAR can reduce intraoperative blood loss,minimize liver function impairment,lower postoperative recurrence rates,and improve survival,thereby enhancing patients'outcomes.
作者
张博雅
李星月
王晶晶
孙银贵
Zhang Boya;Li Xingyue;Wang Jingjing;Sun Yingui(School of Anesthesiology,Shandong Second Medical University,Shandong Weifang 261053,China;Department of Anesthesiology,Affiliated Hospital of Shandong Second Medical University,Shandong Weifang 261035,China;Department of Hepatobiliary Surgery,Affiliated Hospital of Shandong Second Medical University,Shandong Weifang 261035,China;School of Clinical Medicine,Shandong Second Medical University,Shandong Weifang 261053,China)
出处
《腹部外科》
2025年第4期303-308,共6页
Journal of Abdominal Surgery
关键词
原发性肝癌
解剖性肝切除术
腹腔镜
门静脉流域
临床疗效
Primary liver cancer
Anatomical hepatectomy
Laparoscopy
Portal territory
Clinical efficacy
